Men On The Cusp Who Don’t Need Testosterone Yet

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Do all men need testosterone replacement when they develop the symptoms of Testosterone Deficiency. The answer is, sometimes.

When I evaluate the history and lab work of a prospective male patient, I take into account many factors before I accept them as a patient.  None of these are hard and fast “rules”, however my diagnostic “brain” turns them into a final decision about whether they are candidates to have testosterone replacement. This in s a more difficult decision for men than it is for women because men make testosterone from puberty until the day they die and women stop making testosterone after menopause.

Why is this an issue?  When any doctor gives testosterone of any strength to a man, that man’s own production is wiped out.  This is also true for women except women are usually symptomatic when their T is doomed to extinction, and their own production can’t be stimulated, so this decision is easier.  With men, I have to decide whether he has the potential for making a higher dose of his own by providing stimulating  hormones similar to FSH and LH, or by suppressing a competing hormone production like estrone.  This takes experience and complete knowledge of the interactions of hormones for a doctor to make this decision.  I have successfully stimulated T production men under the age of 50 for years when I believe it is indicated.  I can always punt and replace them with T Pellets if they no longer can ramp up their production, but that is my fall back plan.

Let’s look at Joe, a 45 year old man with a total testosterone of 400 (normal young healthy level is 400-1700), and a free testosterone level of 50 pg/ml (normal young healthy level is 129-350). Some men wouldn’t be symptomatic with this level, but most would at any age.  The total T is not a significant number because all but the free testosterone is invisible to the human body.  I only look at the Total T to see if the guy is still producing testosterone is normal amounts, not if he needs T or not.

Joe felt terrible and had ED and virtually every other symptom of low T.  At his age and healthy lifestyle he should not have ED from atherosclerotic arteries, so I felt relatively sure he could fix the ED with an increase in free T.  I suggested he give it a try.  I thought blocking his production of estrogen would increase his free T.  He agreed to two months of Arimidex but no T.  Miraculously, this young man was completely better after that treatment choice, and he does not have to have his T replaced, just stimulated!

Before all my male patients taking T pellets think this is for them, consider the facts:


  • Man under 50
  • Normal genetics XY
  • Normal testicular activity: no damage to the testicles by trauma, viruses, or surgery.
  • Elevated estrogens, OR
  • Low  FSH/LH levels
  • Lower than normal free T


Let me warn those of you who fit these parameters, that sometimes it doesn’t work and I must provide T pellets for replacement and young men do well with that as well, however if you go to a DOC-IN-THE-BOX TESTOSTERONE franchise you will not be given the option and you will have your T wiped out even if you still could produce testosterone at good levels yourself!

This Health cast was written and presented by Dr. Kathy Maupin, M.D., Bio-identical Hormone Replacement Expert and Author, with Brett Newcomb, MA., LPC., Family Counselor, Presenter and Author.  


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